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General NPI Number Information
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NPI Number | 1437813250
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Entity Type | Individual
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Provider Name | LAURA BORREGO GIBBS LPC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 2429 S PRAIRIE AVE
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City | PUEBLO
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State | CO
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Zip | 81005-2886
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Country | US
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Telephone | 719-275-0700
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Fax | 719-896-2874
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Provider Business Mailing Address
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Address Line | PO BOX 1748
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City | CANON CITY
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State | CO
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Zip | 81215-1748
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Country | US
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Telephone | 719-275-0700
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Fax | 719-896-2874
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0004397
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License Number State | CO
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